Connected health--the use of technology to connect people to information, advice, and support-- can help consumers achieve wellness, and patients achieve better health.
What new trends did I find at the Connected Health conference?
First, that the greatest changes are taking place outside of medical practise. Medicine risks being left behind in providing valuable health services to consumers.
Services for consumers are now mediated over the internet and cell phone. The internet-style consumer model is growing and changing and based on the doctor-patient interaction; the medical model for telemedicine is relatively static. However, there are signs that medicine will begin to catch up. Both models are likely to be part of our future, according to Matthew Holt, an authority in health networking. (http://www.thehealthcareblog.com)
Although technology is a key part of the difference between traditional medical models and consumer-oriented services, the technology is not enough. To deliver services to consumers requires a different concept, a different set of priorities, and different business models, contrasted with traditional modes of delivering treatments to patients.
Second, I learned that the technical and social innovations developed by internet innovators can be applied to extend the reach of medicine. There is a range of effective solutions for supporting telemedicine to enable diagnosis, disease management, and improving adherence to treatment, in addition to wellness programs, all at a distance:
- Perhaps the simplest is a phone call. In addition, patients at home can use a land line to connect to a nurse including reports of data like blood pressure readings.
- Conferencing, with data collection and transmission, interactive with nurse of doctor
- A data collecting device could assemble patient data from test devices and sensors, for reporting over a land line to a central monitoring facility.
- For more mobile patients or consumers, wireless phones support monitoring, two-way interaction, automated alarms and reminders.
- Physicians can check routinely and/or computers can instantly flag problems for rapid intervention.
Third, I learned that some healthcare institutions are installing the technology for telemedicine that could eventually be applied widely to a new synthesis and progressive integration of wellness and healthcare, including for disease management.
Finally, I discovered that the technology and service infrastructure is forming that can support mobile healthcare and wellness: cell phones and similar wireless devices that can connect the individual to trusted sources of advice and treatment, including sensors for data measurements comparable to those made in the doctor's office or processed in a lab.
Lifestyle for wellness and prevention
Here's one example of the kinds of initiatives that are being created to serve consumers in the wellness and prevention space. Adam Bosworth got my attention because he presented an analysis of chronic conditions and their impact. This is something that I already knew was important--(see "The chronic disease crisis" ) and I was looking for ways to make a difference. So I was really impressed by the fact that Bosworth saw the big picture and had a feasible plan for introducing change.
Bosworth, co-founder of a health-support system for consumers, KEAS.com, presented a stark analysis of the financial costs of chronic conditions and obesity. He showed projections of the increases in obesity and health care costs over the coming decades as the baby boomer generation ages: "a tidal wave of obesity and chronic disease approaching and no plan to stop it." Did you know the health care costs for obesity can run to $7-20,000 per person each year?
The US spends more on healthcare and has a rather poor life expectancy compared to other nations. "The system is not working," Bosworth concludes.
Reducing obesity can make a huge difference for individuals and the nation.
His idea is to create an alternative: to help people to change their lifestyle to be more healthy and less prone to disease; empower them to be part of the solution. He and his team are building a personalised system to inform people about what they are eating. He wants to give them tools to make better choices; give them rewards for changing their behavior.
The KEAS business model is a massmarket approach with a low price to join; it would act as a publisher of targeted lifestyle (NOT medical) information, creating a user-friendly environment to provide information, feedback, and support.
The key elements in Bosworth's approach are:
- to deal with a lifestyle issue, not something that requires coordination/approval from doctors and the health care system;
- to use the internet and the popular models for social networking to build a mass-market distribution;
- to charge a fee, providing enough income to get off the ground, but low enough so as not to be a barrier.
We see now the emergence of mostly private, entrepreneurial efforts to provide services to consumers to help them manage their wellness. KEAS is but one example, and they haven't yet opened for business. A few of the companies in the wellness, disease prevention, and chronic disease spaces that were represented at the seminar include: WebMD, Diabetic Connect, Inspire; Abacus Health Solutions; carol.com; GenerationOne, Virtual Lifestyle Management, and Sensei. These innovative companies are using a variety of business models to get traction. Some are funded by advertising, by providing data to pharmaceutical companies and other health companies, some sell services to employers or insurers, or charge their consumers.
Their strategies are based on finding ways to help consumers: to give them value that is reinforced immediately and frequently. These techniques, assuming some of them do work effectively, and if applied broadly to preventive and continuing management of chronic care, might well save much suffering, death, and trillions of dollars.
Another example of the new style of help is Sensei.com. Robert Schwarzberg, MD, a cardiologist and the President and CEO of Sensei.com,described their goal: to create a trusted, intelligent interaction, provide support, information and social interaction as needed, and create a positive user experience. Their weight loss program "transforms your mobile phone into a personal health coach and adjusts to your lifestyle and schedule." Programs for a number of additional health concerns are in the works, according to Schwarzberg.
Impact on public health
The good news is that we can now see the elements of a solution to the massive public health problem of chronic conditions. Most chronic conditions can be reversed or managed with changes in lifestyle. The lack of suitable care to prevent, treat, and manage chronic conditions is a national, public health problem, and the nation is the natural client. But I think the support from government has not been as important as initiatives in the private sector.
The bad news is that even the entrepreneurs of lifestyle coaching companies (personal health information services) don't have improving public health as their target. I asked Bosworth, "Given that chronic disease is such a national disaster, and your company may have a method for reversing the trend to obesity which underlies so much chronic disease, what will be your potential for implementing a national solution?" Bosworth hesitated, then said "I can't even think about that. I don't have a long- range plan. I'm worried about making the program work, getting the bugs out of it, I'm interested in trying out our idea and responding to what our consumers will tell us so we can improve."
So Bosworth sees a huge market in reducing chronic conditions by lifestyle changes, but their clients are the first 10,000 or 100,000 consumers, or a company that needs to cut their health care costs. Not the nation.
Medical models for weight loss
Weight management using proven protocols and in-person counseling works, but is expensive. The same methods however can be transferred to the internet, providing effective support for healthy change at much less cost. We see some interesting approaches that blend a scientific, medical model backed by research with online, interactive tools for lifestyle change and disease prevention.
For example, DPS Health is poised to offer an "...internet-based platform that powers patient self-management support interventions." The goal of Virtual Lifestyle Management™, according to the founder, Neal Kaufman, M.D., M.P.H., a physician and professor of public health, is to "...extend the therapeutic relationship between clinician and patient, and help clinicians help their patients adopt and sustain healthy behaviors."
The Virtual Lifestyle Management™ service helps people lose weight, following a program developed and demonstrated effective in clinical trials. The results: better nutrition, weight loss, and diabetes prevention, at lower cost.
Their business model is to partner with providers of health care.
Kaufman saw the conference as confirming the value information technology and the internet can bring to patients and providers. However, Kaufman believes that this can only bear fruit "...if the technology is designed well enough to integrate efficiently into the work flow of clinicians and the daily lives of patients. This will allow patients to get information and support for the hundreds of tiny decisions they make each day that promote or harm their future health." Thus Kaufman has defined the work of DPS Health as "web-based self management support interventions using best practices that mimic the interactions between patients and master clinicians. This allows patients to get the support they need to adopt and sustain healthy behaviors and allows clinicians to be involved with the patients' journey to better health in a cost effective manner."
I asked Kaufman how his approach differs from other "wellness" support systems. Kaufman replied, "The other internet programs provide content and tracking approaches. Our program is a year-long comprehensive intervention that engages patients in their own self management using minimal support from coaches via secure messages,... in addition to automated interactions for content delivery and tracking."
Health care has been moving more slowly. Essentially what is happening in telemedicine is that the basic doctor-patient interaction taking place in the doctor's office is being replicated, but at a distance. New systems enable the gathering and transmission of vital signs and other signs by using blood pressure monitors, oxygen sensors, cameras, etc. to give the doctor data. Phones and teleconferencing systems enable an almost-there interaction experience which can substitute for an in-person encounter. Examples: An impressive conferencing system adapted to distant doctor-patient interaction. Cisco
While the health care system has been slow to adopt electronic records and telemedicine, the parent institution for the seminar organiser, Center for Connected Health, is Partners Healthcare, and they are among the leaders for change in connected health. Partners Healthcare comprises several large teaching hospitals and a growing network of community hospitals and clinics. They have a medical records system that can be accessed from anyplace in the system. They have the capacity to do telemedicine consults internationally, offering consulting services to physicians in other lands. In the last few years they have been working to develop a number of programs for local telemedicine. At the seminar they demonstrated a live interaction, showing how a patient can collect vital signs, and the remote physician can access them and communicate with the patient.
The technical challenges have been significant. The telemedicine industry is maturing, and creating a variety of hardware devices and software that are interoperable--like plug and play in a computer, all manufacturers meet certain compatibility standards. So instead of each institution having to face enormous development and adoption costs, at least the technology has reliability based on a common standards platform. And there can be competition among suppliers of products.
In addition to the basic step of enabling telemedicine for patient care, the Center for Connected Health has begun a number of programs to improve compliance and treatment programs. Hosting the seminar also demonstrated their determination to lead in this area.
What would medical care look like if it adopted the modalities and technologies found in the wellness space? What would medical care look like if it doesn't? Some innovators in wellness and chronic disease feel that the health care system is irrelevant to many needs of patients. Some feel that doctors don't have the tools to practice evidence-based medicine, don't have the resources to track their patients on a daily basis, nor the resources to be present everywhere to give advice or reinforcement. Wellness and consumer-support internet programs can do all these things. Further, patients now participate in innovative research on treatments and other interventions, research that could not be carried out in a medical framework. PatientsLikeMe brings together people with conditions like ALS and MS for sharing, support, and objective tracking of their conditions. A focus of the PatientsLikeMe.com program is to chart data, like symptoms and treatments as in a clinical trial. They understand what empowerment means, and the meaning in altruistic sharing.
For health care of a chronic condition there are beginning to be programs that will help monitor your progress and give you some feedback to keep you on the right track. Chronic disease, however, would be a great fit for the new kinds of consumer-friendly programs but the medical profession is reluctant to get on board. There are some technological advances but the health care system lacks the incentives and infrastructure to make this work. However, there are some new programs that perhaps represent the beginning of a movement by healthcare to adopt some of the feature of consumer-driven services.
Alere (alere.com) helps people with chronic conditions including heart failure, coronary artery disease, diabetes, asthma and COPD to manage their health through at-home monitoring, patient information, and nurse-patient relationships. An effective disease management program can help patients achieve a better quality of life, avoid exacerbations and hospitalizations, and likely save money. The Alere program follows a medical model for extending treatment based on evidence to the home on a daily basis. There is an effort to use professionals to educate and motivate the patient, important ingredients for a successful program. But it doesn't seem ready to go everywhere with the patient, it is home based. Alere has just been acquired by Inverness Medical Innovations, a diagnostic- and monitoring products company.
Other disease management programs provide a data station in the home, along with one or more monitoring devices. These vary in complexity and sophistication, and may involve a central station that receives data from patients, notes changes that might indicate a problem, and can notify a clinician of the situation. Examples: Health Hero
Coaching for wellness and health
I think that human interaction is a basic need to support the change process, not just technology alone which is only a means to establish interaction at a distance. So the idea of coaching to help people learn and modify their behavior would apply in person or across the internet.
Coaching as a metaphor for helping others to improve health or manage disease represents significant movement from the medical model of doctor:patient, and applies to a wide range of health and wellness concerns. Coaching was a popular metaphor at the seminar. One speaker, Cass Sunstein, talked about how to "nudge" people to support change; an online wellness company is named sensei for the Japanese idea for teacher, mentor, or coach; and DPS Health combines clinical "coaches" with software to guide weight loss.
"We’ve squeezed out the power of human relationships in medicine today and sacrificed the full impact of healthcare providers as human catalysts for change," according to Margaret Moore of Wellcoaches Corporation. "What is a wellness coach?" I asked her. Moore said that "coaches help people realize their full potential, navigate their challenges, and make lasting improvement in their health and well-being." Her video, "how coaching works", explains it without a sound.
These developments should be watched carefully for their potential impact on health and wellbeing. People living with chronic conditions may find great benefit in selected programs. COPD, sleep apnea, and a host of other conditions may be better managed with some combination of these new resources. The elderly are often dealing with several chronic conditions that could be monitored effectively using these new capabilities. Be careful and prudent in selecting a program; traditional medical interventions are still needed.
Thank you to the Center for Connected Health
The Center for Connected Health seeks to engage "patients, providers and the connected health community to deliver quality care outside of traditional medical settings." The Center organized a seminar that included presentations by leaders in their fields; in rooms full of very smart and capable people (over 1,000 registered); and coupled with exhibits of state-of-the art technology. The sessions were videotaped and will be available for viewing online. (October 27-28, 2008 Who Provides, Who Decides, Who Pays: Consumers, Clinicians and Business Models in the Connected Care Era)